Understanding of Altitude Illness and Use of Pharmacotherapy Among Trekkers and Porters in the Annapurna Region of Nepal

Abstract

We surveyed Nepali porters and guides as well as English- and non-English-speaking trekkers on their knowledge of altitude illness and its treatment during trekking expeditions to the Annapurna region of Nepal. From March 15 to April 15, 2014, Nepali porters and visiting trekkers were surveyed regarding their ability to recognize and treat altitude illness in Manang, Nepal (3540 m). Their personal use of medications and home remedies and presence of acute mountain sickness (AMS) symptoms were also assessed. 504 subjects were surveyed, including 108 Nepalis. Overall incidence of AMS symptoms was 16%, 5% among Nepalis, and 21% among trekkers. Subjects recognized that headache (88%) was one of the symptoms of AMS, however many reported not knowing the symptoms of high altitude pulmonary edema (40%) or high altitude cerebral edema (42%). 58% of subjects reported carrying and 16% reported taking acetazolamide, while only 2 (0.4%) respondents took dexamethasone. The majority of subjects reported that they would be able to recognize (67%) and treat (62%) altitude illness. Trekkers reported a higher incidence of AMS symptoms than Nepalis. Although most respondents recognized symptoms of AMS, both Nepalis and trekkers lacked knowledge regarding more serious presentations of altitude illness, thus both groups were overconfident in their ability to recognize and treat altitude illness.

Impact of a Newly Constructed Motor Vehicle Road on Altitude Illness in the Nepal Himalayas

“…This finding is consistent with the results of a previous survey conducted among trekkers, porters, and guides in the Annapurna region, which showed that all groups lacked knowledge of altitude illness prevention and recognition. 10 In this study, travel by rapid ascent was more common among Nepali patients than among foreigners. Several other reports, including studies of Nepalis on religious pilgrimage to Gosainkunda Lake (4300 m), [11][12][13] have also documented Nepalis ascending rapidly to high altitude, which suggests they are at particular risk of altitude illness.…”

“…This finding is consistent with the results of a previous survey conducted among trekkers, porters, and guides in the Annapurna region, which showed that all groups lacked knowledge of altitude illness prevention and recognition. 10…”

“…14 Although our study was not able to show a significant increase in the number of cases of HACE or HAPE, partly due to overall low numbers of severe altitude illness in Manang, we believe that due to the easy accessibility of travel by road, life-threatening forms of altitude illness 7 will be more readily encountered among Nepalis, who generally lack awareness of altitude illness and its prevention. 10 More altitude-related dangers may be relevant to this vulnerable population, especially if some continue on over Thorong La while ill with AMS.…”